High Incidence of Apoptosis in Peripheral Blood of Myelodysplastic Syndrome Patients Determined by Papanicolaou-Stained Preparations
Iwao Emura
Department of Surgical Pathology, Nagaoka Red Cross Hospital, Nagaoka, Japan
ABSTRACT:
This study was designed to evaluate the percentage of apoptotic cells (apoptotic index [AI]) in peripheral blood (PB) and bone marrow (BM) as a predictive indicator of BM failure in myelodysplastic syndrome (MDS) patients. PB from 42 patients with primary MDS at diagnosis and BM aspirates from 22 of these 42 patients were analyzed using Papanicolaou-stained preparations. Apoptotic cells were clearly seen in Papanicolaou-stained preparations from all MDS patients and control cases and were confirmed using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL) technique. Apoptotic myeloblasts and promyelocytes were frequently detected in BM; on the other hand, apoptotic neutrophils were abundantly seen in PB. AI values of PB (mean ± SD, 2.15 ± 1.59) and BM (2.55 ± 1.28) of MDS patients were significantly higher than those of control cases (PB, 0.48 ± 0.27; BM, 0.72 ± 0.26). There was a positive correlation between AI values of BM and of PB in MDS patients (r = 0.731; P = .001). The Papanicolaou method was suitable for the observation of apoptotic cells. It was considered that a strong susceptibility to peripheral granulocyte apoptosis was, at least in part, one of the possible causes of granulocytopenia in MDS patients. Furthermore, excessive intramedullary apoptosis was recently reported to cause a poor prognosis (because of an increased risk of death from BM failure) in MDS patients. Therefore, our results indicate that AI of PB is a good indicator of AI in BM, and consequently, of BM failure in MDS patients.
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